title: A novel computerized functional assessment for human immunodeficiency virus-associated neurocognitive disorder.
abstract: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is present in 30-60 % of HIV-positive (HIV+) individuals and can be assessed by neuropsychological testing and level of functional impairment. HAND diagnosis therefore requires accurate assessment of functional impairment. The Computer Assessment of Mild Cognitive Impairment (CAMCI) is a computer-based screening tool that includes performance-based measures of functional impairment. We sought to evaluate the CAMCI as a functional assessment tool in HAND. One hundred fourteen HIV+ patients and 38 HIV-negative (HIV-) patients underwent neuropsychological and CAMCI testing. Cognitive status for HIV+ subjects was classified using the Frascati criteria. HIV+ subjects grouped together and classified by cognitive impairment performed worse than HIV- subjects on several of the CAMCI tasks, including following directions to the supermarket (p = 0.05, p = 0.03), recalling which items to purchase (p = 0.01, p = 0.02), and remembering to stop at a supermarket (p < 0.01, p = 0.01) and the post office (p < 0.01, p = 0.03). After controlling for hepatitis C status and depression symptomatology, the tasks "following directions to the supermarket" and the "recalling which items to purchase" were no longer significant. The "remembering to run two separate errands" tasks retained their significance (p < 0.01 for both tasks). A subset of the CAMCI tasks therefore successfully differentiated HIV+ patients from HIV- individuals. Differences in hepatitis C status and depression symptomatology could account for some of the function assessment differences in the CAMCI. These results suggest the CAMCI could be a useful objective performance-based functional assessment in patients with HIV.
authors.affiliation: Department of Neurology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD, 21287, USA, liana.rosenthal@jhmi.edu.
authors.forename: Liana S
authors.initials: LS
authors.lastname: Rosenthal
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Richard T
authors.initials: RT
authors.lastname: Moxley
authors.forename: Heidi Vornbrock
authors.initials: HV
authors.lastname: Roosa
authors.forename: Ola A
authors.initials: OA
authors.lastname: Selnes
authors.forename: Amy
authors.initials: A
authors.lastname: Eschman
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: Ned
authors.initials: N
authors.lastname: Sacktor
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003936:Diagnosis, Computer-Assisted / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013647:Task Performance and Analysis